Jason Burnett - Academia.edu (original) (raw)
Papers by Jason Burnett
Innovation in Aging, 2019
Financial exploitation (FE) in older adults is a significant public health problem linked to outc... more Financial exploitation (FE) in older adults is a significant public health problem linked to outcomes including depression, financial ruin and early mortality. This study applied exploratory data science techniques to a multi-year statewide protective services dataset of over 8,000 elder abuse cases. The goal was to derive data-driven psychosocial profiles of abuse with an emphasis on determining which factors, commonly shared across abuse cases, were most important for determining when elder FE was occurring and whether it was occurring alone or in conjunction with other types of abuse. We found that pronounced psychological distress (i.e. verbalizing suicide, homicide, self-harm) was most important for indicating when abuse had occurred and predicted non-FE related abuse. Drug paraphernalia in the home and perpetrator drug/alcohol use were important predictors of FE-related abuse. When differentiating pure FE from hybrid FE, factors indicative of long-term FE occurrence and substa...
Journal of Elder Abuse & Neglect, 2020
The Geriatrician clinicians of the Texas Elder Abuse and Mistreatment Institute-Forensic Assessme... more The Geriatrician clinicians of the Texas Elder Abuse and Mistreatment Institute-Forensic Assessment Center Network (TEAM-FACN) in Houston, have many years of experience providing capacity assessment services for Adult Protective Services (APS) and Texas courts. A process has developed which is efficient, consistent, and evidence-informed. In the last two years, telecommunication has been added to this process to conduct assessments of APS clients in areas of Texas remote from the Houston area. Of the 545 capacity assessments TEAM-FACN has completed across the state of Texas over the first two years of adding telecommunication, 211 (39%) were conducted with inperson interviews and 334 (61%) were conducted using videoconference interviews. APS and the courts in remote areas of Texas have embraced the use of the videoconference assisted capacity assessments. This article describes this evidenceinformed process and how telecommunication technology is incorporated to expand the reach of the service.
Innovation in Aging, 2017
Japanese older people with disabilities receive community-based and institutional care services u... more Japanese older people with disabilities receive community-based and institutional care services under the public, mandatory Long-Term Care Insurance (LTCI) system that started in 2000. Levels of provision are among the highest in the world. LTCI includes home nursing, physical therapy and oversight by physicians, but most medical care is covered by health insurance. Integration is a current policy focus, as a means to reduce demand for institutional care by providing "24-hour care" in the community. Specifically, home doctor visits have been encouraged by increasing payments under health insurance, and organizational experiments are being carried out in many localities to improve communication between physicians and LTC care managers. A particular challenge, given the continuing need to control costs, is efficient management of health care and LTC for older people with the heaviest needs. The presentation will discuss integration in the context of distinctive features of Japan's LTCI system.
Journal of elder abuse & neglect, Jan 21, 2016
Elder abuse increases the likelihood of early mortality, but little is known regarding which type... more Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N=1670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical and emotional abuse, financial exploitation and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates; underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical manageme...
Journal of elder abuse & neglect, Jan 30, 2015
Self-neglect among older adults results in increased morbidity and mortality rates. Depression is... more Self-neglect among older adults results in increased morbidity and mortality rates. Depression is strongly linked to self-neglect and when untreated severely complicates management of health and functional outcomes. The study aims to identify factors correlated with depression to inform approaches to service recruitment and retention that improve long-term outcomes. The sample included urban community-dwelling older adults (n = 96), 65-years of age and older with Adult Protective Services substantiated self-neglect. All participants completed a range of validated cognitive, functional and self-report demographic and clinical measures around health and mental health functioning. A secondary data analysis using multivariable logistic regression revealed that a positive screen for alcohol abuse, low self-rated health, and higher self-reported pain were associated with significantly higher odds of self-reported depression. Further research is needed to understand the temporality between...
Disaster Medicine and Public Health Preparedness, 2008
ABSTRACTBackground: In 2005, Hurricane Katrina caused extensive damage to parts of Mississippi, L... more ABSTRACTBackground: In 2005, Hurricane Katrina caused extensive damage to parts of Mississippi, Louisiana, and Alabama, causing many people, including vulnerable older adults, to evacuate to safe surroundings. Approximately 23,000 evacuees—many of them 65 years old or older, frail, and lacking family to advocate for their care—arrived at the Reliant Astrodome Complex in Houston, Texas. There was no method for assessing the immediate and long-term needs of this vulnerable population.Methods: A 13-item rapid needs assessment tool was piloted on 228 evacuees 65 years old and older by the Seniors Without Families Team (SWiFT), to test the feasibility of triaging vulnerable older adults with medical and mental health needs, financial needs, and/or social needs.Results: The average age of the individuals triaged was 66.1 ± 12.72 (mean ± standard deviation [SD]) years. Of these, 68% were triaged for medical and or mental health needs, 18% were triaged for financial assistance, and 4% were ...
Journal of the Society for Social Work and Research, 2014
Drug and Alcohol Dependence, 2015
Clinics in geriatric medicine, 2014
Self-neglect, the most common form of elder mistreatment seen by Adult Protective Service Agencie... more Self-neglect, the most common form of elder mistreatment seen by Adult Protective Service Agencies across the United States, is an often unrecognized geriatric syndrome characterized by squalor and unsafe living circumstances. It is a result of medical, neurologic, or psychiatric disorders coupled with lack of capacity for self-care and self-protection in the absence of necessary services or medical care, and leads to increased morbidity and mortality. Clinicians should evaluate self-neglecters and plan interventions based on comprehensive geriatric assessment and capacity assessment. State and federal policies are needed to address the pressing needs of this vulnerable population of seniors.
Clinical Nursing Studies, 2013
Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older... more Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to self-care and to protect themselves. The specific aims were to determine the feasibility of using multiple EF measures and assess the different dimensions of EF with community-dwelling elders with SN. Methods: In this cross-sectional study, 50 adults aged 65 and older were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following measures: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Descriptive analyses and Pearson correlation coefficients were conducted on the different variables used in this study. Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the other cognitive measures. The low D-KEFS scores indicate difficulties in generating new concepts, inhibiting previous conceptual thoughts, or initiating novel ideas. Conclusions: Results from this study provide support that individuals with SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: "concept generation", "planning, inhibition", and "spatial working memory". Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment. Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN.
Journal of the American Geriatrics Society, 2014
To determine whether there are subtypes of elder self-neglect (SN) with different risk factors th... more To determine whether there are subtypes of elder self-neglect (SN) with different risk factors that can be targeted using medical and social interventions. Cohort study using archived data of Adult Protective Services (APS) substantiated cases of elder SN between January 1, 2004, and December 31, 2008. Houston, Harris County, Texas. Adults aged 65 and older with APS region VI substantiated SN between January 1, 2004, and December 31, 2008 (N = 5,686). Adult Protective Services caseworkers used the Client Assessment and Risk Evaluation (CARE) tool during home investigations, assessing risk of harm in the domains of living conditions, financial status, physical and medical status, mental health, and social connectedness. Latent class analysis was used to identify unique subtypes of elder SN. Four unique subtypes of elder SN were identified, with approximately 50% of individuals manifesting physical and medical neglect problems. Other subtypes included environmental neglect (22%), global neglect (21%), and financial neglect (9%). Older age, Caucasian descent, and mental status problems were more strongly associated with global neglect behaviors. African Americans were more likely to experience financial and environmental neglect than Caucasians and non-white Hispanics. Elder SN consists of unique subtypes that may be amenable to customized multidisciplinary interventions. Future studies are needed to determine whether these subtypes impose differential mortality risks and whether multidisciplinary tailored interventions can reduce SN and prevent early mortality.
Journal of the American Academy of Nurse Practitioners, 2007
Purpose-Self-neglect is the most prevalent finding among cases reported to Adult Protective Servi... more Purpose-Self-neglect is the most prevalent finding among cases reported to Adult Protective Services and is characterized by an inability to meet one's own basic needs. The Kohlman Evaluation of Living Skills (KELS) has been validated in geriatric populations to assess performance with both instrumental (IADL) and basic activities of daily living (ADL), and as an assessment tool for the capacity to live independently, therefore, the purpose of this analysis was to compare the scores of the KELS between substantiated cases of self-neglect and matched community-dwelling elders. Methods-This is a cross-sectional pilot study of 50 adults aged 65 years and older who were recruited from Adult Protective Services (APS) as documented cases of self-neglect and 50 control participants recruited from Harris County Hospital District outpatient clinics. Control participants were matched for age, race, gender and zip code. A geriatric nurse practitioner-led team administered a comprehensive geriatric assessment in homes of all study participants. The assessment included the KELS and Mini-Mental State Examination (MMSE) tests. Chi-square analyses were used to determine if cases of self-neglect were significantly more likely to fail the KELS test than matched controls. Summary of Results-The analyses revealed that self-neglectors were significantly more likely to fail the KELS than non-self-neglectors (50% vs. 30%, p=0.025). When stratified by MMSE scores, self-neglectors with intact cognitive function remained significantly more likely to fail the KELS compared to matched, cognitively intact controls (45% vs. 17%, p=0.013). Conclusion-Abnormal results using an in-home KELS test was significantly associated with substantiated cases of self-neglect. These findings suggest that the KELS test has significant utility as part of a comprehensive geriatric assessment to aid clinicians in suspected cases of self-neglect. Implications for Practice-There is currently no gold standard measure for identifying capacity with self-care behaviors among cases of self-neglect. As a result, self-neglect may remain unidentified in many clinical settings. The KELS provides clinicians with an objective measure of an individual's capacity and performance with everyday life supporting tasks and thus, provides information that can help nurse practitioners identify elders at risk for self-neglect.
Journal of Elder Abuse & Neglect, 2006
Journal of Elder Abuse & Neglect, 2006
Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in a... more Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls. This is a cross-sectional study of 80 (APS) validated cases of self-neglect aged 65 years and older and 80 control participants recruited from a geriatric clinic at Harris County Hospital District. Control participants were matched for age, race, gender, and zip code. Both groups were administered the Wong-Baker FACES rating scale and the Mini-Mental State Examination in their homes by a geriatric nurse practitioner and a research assistant. Self-reported pain was noted in 43% of the self-neglect group compared with only 28% in the control group (X2 = 3.85, df = 1, p = .05). This difference became non-significant after stratifying for MMSE scores of 19 or greater (X2 = 3.38, df = 1, p = .066). The self-neglecting elderly also reported significantly higher levels of pain compared with the matched controls (t = 2.5, df = 143, p = .014). This mean difference remained significant after stratifying by MMSE scores of 19 or greater (t = 2.6, df = 124, p = .009). The data provide preliminary support for the relationship between self-reported pain and elder self-neglect. Research is needed to determine whether pain is a causal or associated factor in self-neglect and whether therapeutic intervention can improve the syndrome of self-neglect.
Journal of Elder Abuse & Neglect, 2006
Objective. There have been no studies describing the occurrence of untreated medical condition(s)... more Objective. There have been no studies describing the occurrence of untreated medical condition(s) in elders with depression who self-neglect. This study compares the prevalence of depression as indicated by an abnormal score (Ն 5) on the Geriatric Depression Scale-Short Form (GDS-SF) between self-neglecters and matched non self-neglecting community-dwelling elders. It also describes the relationship between untreated medical condition(s) associated with self-neglect and abnormal scores on the GDS-SF.
Journal of Elder Abuse & Neglect, 2006
Compared to older adults with disabilities and those who autonomously choose to live in squalor; ... more Compared to older adults with disabilities and those who autonomously choose to live in squalor; self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self care and protection in elders who self-neglect.
Journal of Elder Abuse & Neglect, 2006
Journal of Applied Gerontology, 2010
In older adults, impaired performance in instrumental activities of daily living (ADL) is associa... more In older adults, impaired performance in instrumental activities of daily living (ADL) is associated with vulnerability to harm and diminished capability for safe and independent living. Self-reported measures, despite their limitations, are increasingly used to identify vulnerability in community-living older adults and may not provide accurate evidence of an older adults ability to live safely an independently. A cross-sectional study of 100 older adults with adult protective service substanitated self-neglecting behavior(s), and 100 matched community-living comparisons was conducted to evalaute the association between ADL self-efficacy (ADL-SE) and performance on standardized testing. The Kohlman Evaluation of Living Skills (KELS) and a validated self-report measure of efficacy to perform activities of daily living (ADL) are used. In older adults whose vulnerability presents as self-neglecting behaviors, ADL-SE may not be associated with ADL performance on standardized testing bu...
Innovation in Aging, 2019
Financial exploitation (FE) in older adults is a significant public health problem linked to outc... more Financial exploitation (FE) in older adults is a significant public health problem linked to outcomes including depression, financial ruin and early mortality. This study applied exploratory data science techniques to a multi-year statewide protective services dataset of over 8,000 elder abuse cases. The goal was to derive data-driven psychosocial profiles of abuse with an emphasis on determining which factors, commonly shared across abuse cases, were most important for determining when elder FE was occurring and whether it was occurring alone or in conjunction with other types of abuse. We found that pronounced psychological distress (i.e. verbalizing suicide, homicide, self-harm) was most important for indicating when abuse had occurred and predicted non-FE related abuse. Drug paraphernalia in the home and perpetrator drug/alcohol use were important predictors of FE-related abuse. When differentiating pure FE from hybrid FE, factors indicative of long-term FE occurrence and substa...
Journal of Elder Abuse & Neglect, 2020
The Geriatrician clinicians of the Texas Elder Abuse and Mistreatment Institute-Forensic Assessme... more The Geriatrician clinicians of the Texas Elder Abuse and Mistreatment Institute-Forensic Assessment Center Network (TEAM-FACN) in Houston, have many years of experience providing capacity assessment services for Adult Protective Services (APS) and Texas courts. A process has developed which is efficient, consistent, and evidence-informed. In the last two years, telecommunication has been added to this process to conduct assessments of APS clients in areas of Texas remote from the Houston area. Of the 545 capacity assessments TEAM-FACN has completed across the state of Texas over the first two years of adding telecommunication, 211 (39%) were conducted with inperson interviews and 334 (61%) were conducted using videoconference interviews. APS and the courts in remote areas of Texas have embraced the use of the videoconference assisted capacity assessments. This article describes this evidenceinformed process and how telecommunication technology is incorporated to expand the reach of the service.
Innovation in Aging, 2017
Japanese older people with disabilities receive community-based and institutional care services u... more Japanese older people with disabilities receive community-based and institutional care services under the public, mandatory Long-Term Care Insurance (LTCI) system that started in 2000. Levels of provision are among the highest in the world. LTCI includes home nursing, physical therapy and oversight by physicians, but most medical care is covered by health insurance. Integration is a current policy focus, as a means to reduce demand for institutional care by providing "24-hour care" in the community. Specifically, home doctor visits have been encouraged by increasing payments under health insurance, and organizational experiments are being carried out in many localities to improve communication between physicians and LTC care managers. A particular challenge, given the continuing need to control costs, is efficient management of health care and LTC for older people with the heaviest needs. The presentation will discuss integration in the context of distinctive features of Japan's LTCI system.
Journal of elder abuse & neglect, Jan 21, 2016
Elder abuse increases the likelihood of early mortality, but little is known regarding which type... more Elder abuse increases the likelihood of early mortality, but little is known regarding which types of abuse may be resulting in the greatest mortality risk. This study included N=1670 cases of substantiated elder abuse and estimated the 5-year all-cause mortality for five types of elder abuse (caregiver neglect, physical and emotional abuse, financial exploitation and polyvictimization). Statistically significant differences in 5-year mortality risks were found between abuse types and across gender. Caregiver neglect and financial exploitation had the lowest survival rates; underscoring the value of considering the long-term consequences associated with different forms of abuse. Likewise, mortality differences between genders and abuse types indicate the need to consider this interaction in elder abuse case investigations and responses. Further mortality studies are needed in this population to better understand these patterns and implications for public health and clinical manageme...
Journal of elder abuse & neglect, Jan 30, 2015
Self-neglect among older adults results in increased morbidity and mortality rates. Depression is... more Self-neglect among older adults results in increased morbidity and mortality rates. Depression is strongly linked to self-neglect and when untreated severely complicates management of health and functional outcomes. The study aims to identify factors correlated with depression to inform approaches to service recruitment and retention that improve long-term outcomes. The sample included urban community-dwelling older adults (n = 96), 65-years of age and older with Adult Protective Services substantiated self-neglect. All participants completed a range of validated cognitive, functional and self-report demographic and clinical measures around health and mental health functioning. A secondary data analysis using multivariable logistic regression revealed that a positive screen for alcohol abuse, low self-rated health, and higher self-reported pain were associated with significantly higher odds of self-reported depression. Further research is needed to understand the temporality between...
Disaster Medicine and Public Health Preparedness, 2008
ABSTRACTBackground: In 2005, Hurricane Katrina caused extensive damage to parts of Mississippi, L... more ABSTRACTBackground: In 2005, Hurricane Katrina caused extensive damage to parts of Mississippi, Louisiana, and Alabama, causing many people, including vulnerable older adults, to evacuate to safe surroundings. Approximately 23,000 evacuees—many of them 65 years old or older, frail, and lacking family to advocate for their care—arrived at the Reliant Astrodome Complex in Houston, Texas. There was no method for assessing the immediate and long-term needs of this vulnerable population.Methods: A 13-item rapid needs assessment tool was piloted on 228 evacuees 65 years old and older by the Seniors Without Families Team (SWiFT), to test the feasibility of triaging vulnerable older adults with medical and mental health needs, financial needs, and/or social needs.Results: The average age of the individuals triaged was 66.1 ± 12.72 (mean ± standard deviation [SD]) years. Of these, 68% were triaged for medical and or mental health needs, 18% were triaged for financial assistance, and 4% were ...
Journal of the Society for Social Work and Research, 2014
Drug and Alcohol Dependence, 2015
Clinics in geriatric medicine, 2014
Self-neglect, the most common form of elder mistreatment seen by Adult Protective Service Agencie... more Self-neglect, the most common form of elder mistreatment seen by Adult Protective Service Agencies across the United States, is an often unrecognized geriatric syndrome characterized by squalor and unsafe living circumstances. It is a result of medical, neurologic, or psychiatric disorders coupled with lack of capacity for self-care and self-protection in the absence of necessary services or medical care, and leads to increased morbidity and mortality. Clinicians should evaluate self-neglecters and plan interventions based on comprehensive geriatric assessment and capacity assessment. State and federal policies are needed to address the pressing needs of this vulnerable population of seniors.
Clinical Nursing Studies, 2013
Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older... more Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to self-care and to protect themselves. The specific aims were to determine the feasibility of using multiple EF measures and assess the different dimensions of EF with community-dwelling elders with SN. Methods: In this cross-sectional study, 50 adults aged 65 and older were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following measures: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Descriptive analyses and Pearson correlation coefficients were conducted on the different variables used in this study. Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the other cognitive measures. The low D-KEFS scores indicate difficulties in generating new concepts, inhibiting previous conceptual thoughts, or initiating novel ideas. Conclusions: Results from this study provide support that individuals with SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: "concept generation", "planning, inhibition", and "spatial working memory". Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment. Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN.
Journal of the American Geriatrics Society, 2014
To determine whether there are subtypes of elder self-neglect (SN) with different risk factors th... more To determine whether there are subtypes of elder self-neglect (SN) with different risk factors that can be targeted using medical and social interventions. Cohort study using archived data of Adult Protective Services (APS) substantiated cases of elder SN between January 1, 2004, and December 31, 2008. Houston, Harris County, Texas. Adults aged 65 and older with APS region VI substantiated SN between January 1, 2004, and December 31, 2008 (N = 5,686). Adult Protective Services caseworkers used the Client Assessment and Risk Evaluation (CARE) tool during home investigations, assessing risk of harm in the domains of living conditions, financial status, physical and medical status, mental health, and social connectedness. Latent class analysis was used to identify unique subtypes of elder SN. Four unique subtypes of elder SN were identified, with approximately 50% of individuals manifesting physical and medical neglect problems. Other subtypes included environmental neglect (22%), global neglect (21%), and financial neglect (9%). Older age, Caucasian descent, and mental status problems were more strongly associated with global neglect behaviors. African Americans were more likely to experience financial and environmental neglect than Caucasians and non-white Hispanics. Elder SN consists of unique subtypes that may be amenable to customized multidisciplinary interventions. Future studies are needed to determine whether these subtypes impose differential mortality risks and whether multidisciplinary tailored interventions can reduce SN and prevent early mortality.
Journal of the American Academy of Nurse Practitioners, 2007
Purpose-Self-neglect is the most prevalent finding among cases reported to Adult Protective Servi... more Purpose-Self-neglect is the most prevalent finding among cases reported to Adult Protective Services and is characterized by an inability to meet one's own basic needs. The Kohlman Evaluation of Living Skills (KELS) has been validated in geriatric populations to assess performance with both instrumental (IADL) and basic activities of daily living (ADL), and as an assessment tool for the capacity to live independently, therefore, the purpose of this analysis was to compare the scores of the KELS between substantiated cases of self-neglect and matched community-dwelling elders. Methods-This is a cross-sectional pilot study of 50 adults aged 65 years and older who were recruited from Adult Protective Services (APS) as documented cases of self-neglect and 50 control participants recruited from Harris County Hospital District outpatient clinics. Control participants were matched for age, race, gender and zip code. A geriatric nurse practitioner-led team administered a comprehensive geriatric assessment in homes of all study participants. The assessment included the KELS and Mini-Mental State Examination (MMSE) tests. Chi-square analyses were used to determine if cases of self-neglect were significantly more likely to fail the KELS test than matched controls. Summary of Results-The analyses revealed that self-neglectors were significantly more likely to fail the KELS than non-self-neglectors (50% vs. 30%, p=0.025). When stratified by MMSE scores, self-neglectors with intact cognitive function remained significantly more likely to fail the KELS compared to matched, cognitively intact controls (45% vs. 17%, p=0.013). Conclusion-Abnormal results using an in-home KELS test was significantly associated with substantiated cases of self-neglect. These findings suggest that the KELS test has significant utility as part of a comprehensive geriatric assessment to aid clinicians in suspected cases of self-neglect. Implications for Practice-There is currently no gold standard measure for identifying capacity with self-care behaviors among cases of self-neglect. As a result, self-neglect may remain unidentified in many clinical settings. The KELS provides clinicians with an objective measure of an individual's capacity and performance with everyday life supporting tasks and thus, provides information that can help nurse practitioners identify elders at risk for self-neglect.
Journal of Elder Abuse & Neglect, 2006
Journal of Elder Abuse & Neglect, 2006
Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in a... more Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls. This is a cross-sectional study of 80 (APS) validated cases of self-neglect aged 65 years and older and 80 control participants recruited from a geriatric clinic at Harris County Hospital District. Control participants were matched for age, race, gender, and zip code. Both groups were administered the Wong-Baker FACES rating scale and the Mini-Mental State Examination in their homes by a geriatric nurse practitioner and a research assistant. Self-reported pain was noted in 43% of the self-neglect group compared with only 28% in the control group (X2 = 3.85, df = 1, p = .05). This difference became non-significant after stratifying for MMSE scores of 19 or greater (X2 = 3.38, df = 1, p = .066). The self-neglecting elderly also reported significantly higher levels of pain compared with the matched controls (t = 2.5, df = 143, p = .014). This mean difference remained significant after stratifying by MMSE scores of 19 or greater (t = 2.6, df = 124, p = .009). The data provide preliminary support for the relationship between self-reported pain and elder self-neglect. Research is needed to determine whether pain is a causal or associated factor in self-neglect and whether therapeutic intervention can improve the syndrome of self-neglect.
Journal of Elder Abuse & Neglect, 2006
Objective. There have been no studies describing the occurrence of untreated medical condition(s)... more Objective. There have been no studies describing the occurrence of untreated medical condition(s) in elders with depression who self-neglect. This study compares the prevalence of depression as indicated by an abnormal score (Ն 5) on the Geriatric Depression Scale-Short Form (GDS-SF) between self-neglecters and matched non self-neglecting community-dwelling elders. It also describes the relationship between untreated medical condition(s) associated with self-neglect and abnormal scores on the GDS-SF.
Journal of Elder Abuse & Neglect, 2006
Compared to older adults with disabilities and those who autonomously choose to live in squalor; ... more Compared to older adults with disabilities and those who autonomously choose to live in squalor; self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self care and protection in elders who self-neglect.
Journal of Elder Abuse & Neglect, 2006
Journal of Applied Gerontology, 2010
In older adults, impaired performance in instrumental activities of daily living (ADL) is associa... more In older adults, impaired performance in instrumental activities of daily living (ADL) is associated with vulnerability to harm and diminished capability for safe and independent living. Self-reported measures, despite their limitations, are increasingly used to identify vulnerability in community-living older adults and may not provide accurate evidence of an older adults ability to live safely an independently. A cross-sectional study of 100 older adults with adult protective service substanitated self-neglecting behavior(s), and 100 matched community-living comparisons was conducted to evalaute the association between ADL self-efficacy (ADL-SE) and performance on standardized testing. The Kohlman Evaluation of Living Skills (KELS) and a validated self-report measure of efficacy to perform activities of daily living (ADL) are used. In older adults whose vulnerability presents as self-neglecting behaviors, ADL-SE may not be associated with ADL performance on standardized testing bu...